http://www.resource-allocation.com The most accessed research articles published by Cost Effectiveness and Resource Allocation 2011-12-20T00:00:00Z Background: Health organizations the world over are required to set priorities and allocate resources within the constraint of limited funding. However, decision makers may not be well equipped to make explicit rationing decisions and as such often rely on historical or political resource allocation processes. One economic approach to priority setting which has gained momentum in practice over the last three decades is program budgeting and marginal analysis (PBMA). Methods: This paper presents a detailed step by step guide for carrying out a priority setting process based on the PBMA framework. This guide is based on the authors' experience in using this approach primarily in the UK and Canada, but as well draws on a growing literature of PBMA studies in various countries. Results: At the core of the PBMA approach is an advisory panel charged with making recommendations for resource re-allocation. The process can be supported by a range of 'hard' and 'soft' evidence, and requires that decision making criteria are defined and weighted in an explicit manner. Evaluating the process of PBMA using an ethical framework, and noting important challenges to such activity including that of organizational behavior, are shown to be important aspects of developing a comprehensive approach to priority setting in health care. Conclusion: Although not without challenges, international experience with PBMA over the last three decades would indicate that this approach has the potential to make substantial improvement on commonly relied upon historical and political decision making processes. In setting out a step by step guide for PBMA, as is done in this paper, implementation by decision makers should be facilitated. http://www.resource-allocation.com/content/2/1/3 Craig Mitton Cam Donaldson Cost Effectiveness and Resource Allocation 2004, null:3 2004-04-22T00:00:00Z doi:10.1186/1478-7547-2-3 /content/figures/1478-7547-2-3-toc.gif Cost Effectiveness and Resource Allocation 1478-7547 ${item.volume} 3 2004-04-22T00:00:00Z XML Information on the unit cost of inpatient and outpatient care is an essential element for costing, budgeting and economic-evaluation exercises. Many countries lack reliable estimates, however. WHO has recently undertaken an extensive effort to collect and collate data on the unit cost of hospitals and health centres from as many countries as possible; so far, data have been assembled from 49 countries, for various years during the period 1973–2000. The database covers a total of 2173 country-years of observations. Large gaps remain, however, particularly for developing countries. Although the long-term solution is that all countries perform their own costing studies, the question arises whether it is possible to predict unit costs for different countries in a standardized way for short-term use. The purpose of the work described in this paper, a modelling exercise, was to use the data collected across countries to predict unit costs in countries for which data are not yet available, with the appropriate uncertainty intervals.The model presented here forms part of a series of models used to estimate unit costs for the WHO-CHOICE project. The methods and the results of the model, however, may be used to predict a number of different types of country-specific unit costs, depending on the purpose of the exercise. They may be used, for instance, to estimate the costs per bed-day at different capacity levels; the "hotel" component of cost per bed-day; or unit costs net of particular components such as drugs.In addition to reporting estimates for selected countries, the paper shows that unit costs of hospitals vary within countries, sometimes by an order of magnitude. Basing cost-effectiveness studies or budgeting exercises on the results of a study of a single facility, or even a small group of facilities, is likely to be misleading. http://www.resource-allocation.com/content/1/1/3 Taghreed Adam David Evans Christopher Murray Cost Effectiveness and Resource Allocation 2003, null:3 2003-02-26T00:00:00Z doi:10.1186/1478-7547-1-3 /content/figures/1478-7547-1-3-toc.gif Cost Effectiveness and Resource Allocation 1478-7547 ${item.volume} 3 2003-02-26T00:00:00Z XML Priority setting of health interventions is often ad-hoc and resources are not used to an optimal extent. Underlying problem is that multiple criteria play a role and decisions are complex. Interventions may be chosen to maximize general population health, to reduce health inequalities of disadvantaged or vulnerable groups, ad/or to respond to life-threatening situations, all with respect to practical and budgetary constraints. This is the type of problem that policy makers are typically bad at solving rationally, unaided. They tend to use heuristic or intuitive approaches to simplify complexity, and in the process, important information is ignored. Next, policy makers may select interventions for only political motives.This indicates the need for rational and transparent approaches to priority setting. Over the past decades, a number of approaches have been developed, including evidence-based medicine, burden of disease analyses, cost-effectiveness analyses, and equity analyses. However, these approaches concentrate on single criteria only, whereas in reality, policy makers need to make choices taking into account multiple criteria simultaneously. Moreover, they do not cover all criteria that are relevant to policy makers.Therefore, the development of a multi-criteria approach to priority setting is necessary, and this has indeed recently been identified as one of the most important issues in health system research. In other scientific disciplines, multi-criteria decision analysis is well developed, has gained widespread acceptance and is routinely used. This paper presents the main principles of multi-criteria decision analysis. There are only a very few applications to guide resource allocation decisions in health. We call for a shift away from present priority setting tools in health – that tend to focus on single criteria – towards transparent and systematic approaches that take into account all relevant criteria simultaneously. http://www.resource-allocation.com/content/4/1/14 Rob Baltussen Louis Niessen Cost Effectiveness and Resource Allocation 2006, null:14 2006-08-21T00:00:00Z doi:10.1186/1478-7547-4-14 /content/figures/1478-7547-4-14-toc.gif Cost Effectiveness and Resource Allocation 1478-7547 ${item.volume} 14 2006-08-21T00:00:00Z XML Cost-effectiveness analysis (CEA) is potentially an important aid to public health decision-making but, with some notable exceptions, its use and impact at the level of individual countries is limited. A number of potential reasons may account for this, among them technical shortcomings associated with the generation of current economic evidence, political expediency, social preferences and systemic barriers to implementation. As a form of sectoral CEA, Generalized CEA sets out to overcome a number of these barriers to the appropriate use of cost-effectiveness information at the regional and country level. Its application via WHO-CHOICE provides a new economic evidence base, as well as underlying methodological developments, concerning the cost-effectiveness of a range of health interventions for leading causes of, and risk factors for, disease.The estimated sub-regional costs and effects of different interventions provided by WHO-CHOICE can readily be tailored to the specific context of individual countries, for example by adjustment to the quantity and unit prices of intervention inputs (costs) or the coverage, efficacy and adherence rates of interventions (effectiveness). The potential usefulness of this information for health policy and planning is in assessing if current intervention strategies represent an efficient use of scarce resources, and which of the potential additional interventions that are not yet implemented, or not implemented fully, should be given priority on the grounds of cost-effectiveness.Health policy-makers and programme managers can use results from WHO-CHOICE as a valuable input into the planning and prioritization of services at national level, as well as a starting point for additional analyses of the trade-off between the efficiency of interventions in producing health and their impact on other key outcomes such as reducing inequalities and improving the health of the poor. http://www.resource-allocation.com/content/1/1/8 Raymond Hutubessy Dan Chisholm Tessa Tan-Torres Edejer Cost Effectiveness and Resource Allocation 2003, null:8 2003-12-19T00:00:00Z doi:10.1186/1478-7547-1-8 /content/figures/1478-7547-1-8-toc.gif Cost Effectiveness and Resource Allocation 1478-7547 ${item.volume} 8 2003-12-19T00:00:00Z XML Background: Telemedicine has been advocated as an effective means to provide health care services over a distance. Systematic information on costs and consequences has been called for to support decision-making in this field. This paper provides a review of the quality, validity and generalisability of economic evaluations in telemedicine. Methods: A systematic literature search in all relevant databases was conducted and forms the basis for addressing these issues. Only articles published in peer-reviewed journals and written in English in the period from 1990 to 2007 were analysed. The literature search identified 33 economic evaluations where both costs (resource use) and outcomes (non-resource consequences) were measured. Results: This review shows that economic evaluations in telemedicine are highly diverse in terms of both the study context and the methods applied. The articles covered several medical specialities ranging from cardiology and dermatology to psychiatry. The studies analysed telemedicine in home care, and in primary and secondary care settings using a variety of different technologies including videoconferencing, still-images and monitoring (store-and-forward telemedicine). Most studies used multiple outcome measures and analysed the effects using disaggregated cost-consequence frameworks. Objectives, study design, and choice of comparators were mostly well reported. The majority of the studies lacked information on perspective and costing method, few used general statistics and sensitivity analysis to assess validity, and even fewer used marginal analysis. Conclusion: As this paper demonstrates, the majority of the economic evaluations reviewed were not in accordance with standard evaluation techniques. Further research is needed to explore the reasons for this and to address how economic evaluation in telemedicine best can take advantage of local constraints and at the same time produce valid and generalisable results. http://www.resource-allocation.com/content/7/1/18 Trine Bergmo Cost Effectiveness and Resource Allocation 2009, null:18 2009-10-24T00:00:00Z doi:10.1186/1478-7547-7-18 /content/figures/1478-7547-7-18-toc.gif Cost Effectiveness and Resource Allocation 1478-7547 ${item.volume} 18 2009-10-24T00:00:00Z XML Estimating the costs of health interventions is important to policy-makers for a number of reasons including the fact that the results can be used as a component in the assessment and improvement of their health system performance. Costs can, for example, be used to assess if scarce resources are being used efficiently or whether there is scope to reallocate them in a way that would lead to improvements in population health. As part of its WHO-CHOICE project, WHO has been developing a database on the overall costs of health interventions in different parts of the world as an input to discussions about priority setting.Programme costs, defined as costs incurred at the administrative levels outside the point of delivery of health care to beneficiaries, may comprise an important component of total costs. Cost-effectiveness analysis has sometimes omitted them if the main focus has been on personal curative interventions or on the costs of making small changes within the existing administrative set-up. However, this is not appropriate for non-personal interventions where programme costs are likely to comprise a substantial proportion of total costs, or for sectoral analysis where questions of how best to reallocate all existing health resources, including administrative resources, are being considered.This paper presents a first effort to systematically estimate programme costs for many health interventions in different regions of the world. The approach includes the quantification of resource inputs, choice of resource prices, and accounts for different levels of population coverage. By using an ingredients approach, and making tools available on the World Wide Web, analysts can adapt the programme costs reported here to their local settings. We report results for a selected number of health interventions and show that programme costs vary considerably across interventions and across regions, and that they can contribute substantially to the overall costs of interventions. http://www.resource-allocation.com/content/1/1/1 Benjamin Johns Rob Baltussen Raymond Hutubessy Cost Effectiveness and Resource Allocation 2003, null:1 2003-02-26T00:00:00Z doi:10.1186/1478-7547-1-1 /content/figures/1478-7547-1-1-toc.gif Cost Effectiveness and Resource Allocation 1478-7547 ${item.volume} 1 2003-02-26T00:00:00Z XML The Transition cost accounting system integrates clinical, resource utilization, and financial information and is currently being used by several hospitals in Canada and the United States to calculate the costs of patient care. Our objectives were to review the use of hospital-based cost accounting systems to measure costs of treatment and discuss potential use of the Transition cost accounting system in health services research. Such systems provide internal reports to administrators for formulating major policies and strategic plans for future activities. Our review suggests that the Transition cost accounting information system may useful for estimating in-hospital costs of treatment. http://www.resource-allocation.com/content/5/1/11 Arik Azoulay Nadine Doris Kristian Filion Joanna Caron Louise Pilote Mark Eisenberg Cost Effectiveness and Resource Allocation 2007, null:11 2007-08-08T00:00:00Z doi:10.1186/1478-7547-5-11 /content/figures/1478-7547-5-11-toc.gif Cost Effectiveness and Resource Allocation 1478-7547 ${item.volume} 11 2007-08-08T00:00:00Z XML The Expanded Program of Immunization (EPI) offers services to the population free of charge but these activities are costly with the greatest part being the cost of vaccines. In spite of the growing international solidarity towards funding for immunization, the growing objectives continue to outweigh the available resources. It is therefore crucial for any immunization system to seek greater efficiency so as to optimize the use of available means in a bid to ensure sustainability. It is in this light that we carried out this study which aims to assess the productive efficiency of routine EPI for children aged 0 - 11 months with respect to the fixed and outreach vaccine delivery strategies in Ngong health district. The study is descriptive and cross-sectional. Data were collected retrospectively for all 16 health centers of the district that offered EPI services during the period February - May 2009.The results show that:• Only 62% of planned outreach immunization sessions were effectively carried out mainly due to limited funds for transportation and staff availability. Consequently vaccine coverage was low (BCG: 70.1%, DPT-HB-Hib 3: 55.5%) and less resources (43%) were used for this strategy which served 52% of the target population - a major blow to equity.• The average cost per Fully Immunized Child (FIC) was 9,571 FCFA (19.22 USD) for the fixed strategy; 12,751 FCFA (25.61 USD) for the outreach and 10,718 FCFA (21.53 USD) with both strategies combined. These figures are high than those observed in many other African health districts. However, DPT-HB-Hib and yellow fever vaccines contributed to the increase as vaccines occupied 57% of the total cost. With DPT in lieu of DPT-HB-Hib the cost/FIC would be 6,046 FCFA (12.14 USD). Dropout rates too were high (28.1% for the fixed, 29.7% for outreach).• The cost of vaccines wasted in excess of the national norm at the level of health centers was 595,532 FCFA (1,196.15 USD), an amount that could cover the vaccine cost for 122 FIC (7.6% of the FIC during the period). This was accounted for as follows: BCG 1.1%, OPV 1.4%, DPT-HB-Hib 72.7%, measles 5.3%, yellow fever 19.5%• Therefore we suggest improved communication for EPI, the introduction of DPT-HB-Hib with liquid Hib and the effective implementation of planned outreach sessions. http://www.resource-allocation.com/content/9/1/9 Cliford Ebong Pierre Levy Cost Effectiveness and Resource Allocation 2011, null:9 2011-05-28T00:00:00Z doi:10.1186/1478-7547-9-9 /content/figures/1478-7547-9-9-toc.gif Cost Effectiveness and Resource Allocation 1478-7547 ${item.volume} 9 2011-05-28T00:00:00Z XML Background: Adherence to antiretroviral medication regimens is essential to good clinical outcomes for HIV-infected patients. Little is known about the costs of case management (CM) designed to improve adherence for patients identified as being at risk for poor adherence in resource-constrained settings. This study analyzed the costs, outputs, unit costs and correlates of unit cost variation for CM services in 14 ART sites in Ethiopia from October 2008 through September 2009. Methods: This study applied standard micro-costing methods to identify the incremental costs of the CM program. We divided total CM-attributable costs by three output measures (patient-quarters of CM services delivered, number of patients served and successful patient exits) to derive three separate indices of unit costs. The relationships between unit costs and two operational factors (scale and service-volume to staff ratios) were quantified through bivariate analyses. Results: The CM program delivered 4,598 patient-quarters of services, serving 5,056 patients and 1,995 successful exits at a cost of $167,457 over 12 months, or $36 per patient-quarter, $33 per patient served and $84 per successful exit from the CM program. Among the 14 sites, mean costs were $11,961 (sd, $3,965) for the 12-month study period, and $51 (sd, $36) per patient-quarter; $48 (sd, $32) per patient served; and $183 (sd, $157) per successful exit. Unit costs varied inversely with scale (r, -0.70 for cost per patient-quarter versus patient-quarters of service) and with the service-volume to staff ratio (r, -0.68 for cost per patient-quarter versus staff per patient-quarter). Conclusions: For those receiving CM, the program adds 0.52% to the lifetime cost of ART. These data reflect wide variation in unit costs among the study sites and suggest that high patient volume may be a major determinant of CM program efficiency. The observed variations in unit costs also indicate that there may be opportunities to identify staffing patterns that increase overall program efficiency. http://www.resource-allocation.com/content/9/1/18 Elliot Marseille Sebastian Kevany Ismael Ahmed Getachew Feleke Bill Graham Thomas Heller James Kahn Michael Reyes Cost Effectiveness and Resource Allocation 2011, null:18 2011-12-20T00:00:00Z doi:10.1186/1478-7547-9-18 /content/figures/1478-7547-9-18-toc.gif Cost Effectiveness and Resource Allocation 1478-7547 ${item.volume} 18 2011-12-20T00:00:00Z XML Background: Type 2 diabetes mellitus (T2D) poses a large worldwide burden for health care systems. One possible tool to decrease this burden is primary prevention. As it is unethical to wait until perfect data are available to conclude whether T2D primary prevention intervention programmes are cost-effective, we need a model that simulates the effect of prevention initiatives. Thus, the aim of this study is to investigate the long-term cost-effectiveness of lifestyle intervention programmes for the prevention of T2D using a Markov model. As decision makers often face difficulties in applying health economic results, we visualise our results with health economic tools. Methods: We use four-state Markov modelling with a probabilistic cohort analysis to calculate the cost per quality-adjusted life year (QALY) gained. A one-year cycle length and a lifetime time horizon are applied. Best available evidence supplies the model with data on transition probabilities between glycaemic states, mortality risks, utility weights, and disease costs. The costs are calculated from a societal perspective. A 3% discount rate is used for costs and QALYs. Cost-effectiveness acceptability curves are presented to assist decision makers. Results: The model indicates that diabetes prevention interventions have the potential to be cost-effective, but the outcome reveals a high level of uncertainty. Incremental cost-effectiveness ratios (ICERs) were negative for the intervention, ie, the intervention leads to a cost reduction for men and women aged 30 or 50 years at initiation of the intervention. For men and women aged 70 at initiation of the intervention, the ICER was EUR27,546/QALY gained and EUR19,433/QALY gained, respectively. In all cases, the QALYs gained were low. Cost-effectiveness acceptability curves show that the higher the willingness-to-pay threshold value, the higher the probability that the intervention is cost-effective. Nonetheless, all curves are flat. The threshold value of EUR50,000/QALY gained has a 30-55% probability that the intervention is cost-effective. Conclusions: Lifestyle interventions for primary prevention of type 2 diabetes are cost-saving for men and women aged 30 or 50 years at the start of the intervention, and cost-effective for men and women aged 70 years. However, there is a high degree of uncertainty around the ICERs. With the conservative approach adopted for this model, the long-term effectiveness of the intervention could be underestimated. http://www.resource-allocation.com/content/9/1/17 Anne Neumann Peter Schwarz Lars Lindholm Cost Effectiveness and Resource Allocation 2011, null:17 2011-11-18T00:00:00Z doi:10.1186/1478-7547-9-17 /content/figures/1478-7547-9-17-toc.gif Cost Effectiveness and Resource Allocation 1478-7547 ${item.volume} 17 2011-11-18T00:00:00Z XML